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Biomedical subjects

M Capuzzo

Publications and source records attributed to M Capuzzo.

At least 19 recordsLinked to original sources

Emotional and interpersonal factors are most important for patient satisfaction with anaesthesia.

BACKGROUND: Questionnaires to evaluate patient satisfaction with anaesthesia mainly consider physiological aspects. This study was performed to identify the items of value for patients having anaesthesia (pilot phase) and to validate the questionnaire built on these findings in a new group of inpatients. METHODS: In the pilot phase, 100 surgical patients were interviewed and asked whether each of the 23 items selected by a panel of providers was relevant (score 1) and to rank these from 1 (additional score 6) to 5 (additional score 2). The resulting 10-item final instrument was administered to 219 consecutive inpatients by interview, after recent anaesthesia, asking them how much of each item they received (item received) and the level of satisfaction with the same item, using Numerical Rating Scales (range 0-10). RESULTS: In the pilot phase, gender, age, education and surgery did not influence the score enough to change the first 10 rank-ordered items. The 219 patients subsequently studied did not differ from those missing the questionnaire administration. The patients aged less than 55 years showed lower satisfaction scores than those aged 55 years or more (P = 0.019). In all items, except 'feeling anxious/frightened', the item received was significantly associated with the satisfaction reported. 'Kindness/regard of caregivers' together with 'information given by anaesthetist' and 'feeling safe' predicted 47% of the variance in total patient satisfaction. CONCLUSIONS: Inpatients value highly those elements of care that pertain to emotional and interpersonal relationships.

Adult↗

The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstructive pulmonary disease.

We examined the effect of isoflurane and sevoflurane on respiratory system resistance (Rmin,rs) in patients with chronic obstructive pulmonary disease (COPD). The diagnosis of COPD rests on the presence of airway obstruction, which is only partially reversible after bronchodilator treatment. Ninety-six consecutive patients undergoing thoracic surgery for peripheral lung cancer were enrolled. They were divided into two groups: preoperative forced expiratory volume in 1 s/forced vital capacity ratio <70% or >70%. Rmin,rs was measured after 5 and 10 min of maintenance anesthesia by using the constant flow/rapid occlusion method. Maintenance of anesthesia was randomized to thiopental 0.30 mg . kg(-1) . min(-1) or 1.1 minimum alveolar anesthetic concentration end-tidal isoflurane or sevoflurane. Eleven patients were excluded: two because anesthesia was erroneously induced with propofol and nine because of an incorrect tube position. Maintenance with thiopental failed to decrease Rmin,rs, whereas both volatile anesthetics were able to decrease Rmin,rs in patients with COPD. The percentage of patients who did not respond to volatile anesthetics was larger in those with COPD as well. In conclusion, we have demonstrated that isoflurane and sevoflurane produce bronchodilation in patients with COPD.

Aged↗

Post-traumatic stress disorder-related symptoms after intensive care.

AIM: To determine the incidence of Post Traumatic Stress Disorder (PTSD) related symptoms in a population of intensive care unit (ICU) admitted patients and the relationship between PTSD-related symptoms and memories of ICU. METHODS: Adults consecutively admitted to an ICU of a University hospital during 1 year, who stayed in the ICU at least 3 days, were prospectively studied. A questionnaire (ICU memory tool) was administered to 84 patients 1 week after ICU discharge and to 63 of them after 3 months. Past medical history and clinical variables present during ICU stay were collected. RESULTS: At the 1st interview, 5 patients (5.9%) did not remember to have been in ICU. Of the remaining 79 patients (males 59.5%, median age 69 years, SAPS II 34, APACHE II 14 and ICU stay 5 days), 4 reported intrusive memories and none panic attacks. The Impact of Events Scale (IES), available in 3 of them, scored in medium/high levels. Only the median number of factual memories reported by the patients with and without intrusive memories was significantly different (4 interquartile range 2-5 vs 8 interquartile range 6-10; p=0.002). The patients with intrusive memories at the 1st interview did not report them at the 2nd interview. Two patients not having panic or intrusive memories at the 1st interview reported PTSD-related symptoms after 3 months. CONCLUSIONS: In a general ICU population, few patients (5%) have PTSD-related symptoms and those who present those symptoms report less factual memories of ICU stay.

Aged↗

Analgesia, sedation, and memory of intensive care.

PURPOSE: The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care. PATIENTS AND METHODS: One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives. RESULTS: The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P <.05), and had a shorter ICU stay (P <.01). Group C patients were more seriously ill according to SAPS II, duration of mechanical ventilation, and length of stay in ICU and in hospital (P <.001). The incidence of factual, sensation, and emotional memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59). CONCLUSIONS: The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males.

Adult↗

Validation of two quality of life questionnaires suitable for intensive care patients.

OBJECTIVE: To validate two instruments measuring quality of life (QOL) suitable for patients admitted to the intensive care unit (ICU): QOL-IT and QOL-SP. DESIGN: Prospective study using patient interviews. SETTING: Two four-bed surgical-medical ICUs in a 960-bed teaching hospital. PATIENTS AND METHODS: One hundred seventy-two adult, co-operative patients consecutively admitted to ICU for more than 24 h were interviewed. One year after hospital discharge, 84 survivors were interviewed again. Inter-observer reproducibility was investigated in 36 patients. To validate the instruments, the QOL-IT and QOL-SP scores reported by patients were considered according to the functional limitation evaluated by the interviewer. Moreover, the theoretical prediction that patients with chronic diseases should have a worse QOL before ICU admission than patients with only acute illness was tested. QOL-IT and QOL-SP scores given 1 year after hospital discharge were compared with those recorded at the first interview. RESULTS: Inter-observer reproducibility was excellent. The possible range of QOL-IT is 0-20 and that of QOL-SP 0-29. According to the functional limitation (absent, mild or severe), the median QOL-IT score increased from 3 to 6 to 13 and QOL-SP from 2 to 6 to 12 (p< 0.0001). The patients with chronic diseases gave scores significantly higher than the patients with only acute illness (median QOL-IT 8 versus 3, p< 0.013; QOL-SP 8 versus 4, p< 0.004). The median QOL-IT score changed from 3 to 4 one year after hospital discharge, a difference which is statistically (p< 0.001), but not clinically, significant. The median QOL-SP score was 3 and did not change. CONCLUSIONS: QOL-IT and QOL-SP are instruments able to discriminate between different health states.

Aged↗

Validation of severity scoring systems SAPS II and APACHE II in a single-center population.

OBJECTIVE: To validate two severity scoring systems, the Simplified Acute Physiology Score (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE II), in a single-center ICU population. DESIGN AND SETTING: Prospective data collection in a two four-bed multidisciplinary ICUs of a teaching hospital. PATIENTS AND METHODS: Data were collected in ICU over 4 years on 1,721 consecutively admitted patients (aged 18 years or older, no transferrals, ICU stay at least 24 h) regarding SAPS II, APACHE II, predicted hospital mortality, and survival upon hospital discharge. RESULTS: At the predicted risk of 0.5, sensitivity was 39.4 % for SAPS II and 31.6 % for APACHE II, specificity 95.6 % and 97.2 %, and correct classification rate 85.6 % and 85.5 %, respectively. The area under the ROC curve was higher than 0.8 for both models. The goodness-of-fit statistic showed no significant difference between observed and predicted hospital mortality (H = 7.62 for SAPS II, H = 3.87 for APACHE II; and C = 9.32 and C = 5.05, respectively). Observed hospital mortality of patients with risk of death higher than 60 % was overpredicted by SAPS II and underpredicted by APACHE II. The observed hospital mortality was significantly higher than that predicted by the models in medical patients and in those admitted from the ward. CONCLUSIONS: This study validates both SAPS II and APACHE II scores in an ICU population comprised mainly of surgical patients. The type of ICU admission and the location in the hospital before ICU admission influence the predictive ability of the models.

APACHE↗

Quality of life before intensive care admission: agreement between patient and relative assessment.

OBJECTIVE: To assess the agreement between patients and relatives concerning the formers' quality of life (QOL) before intensive care unit (ICU) admission. DESIGN: Prospective study involving direct interviews of patients and relatives during ICU stay. SETTING: Two four-bed surgical-medical ICUs in a 960-bed teaching hospital. PATIENTS AND METHODS: A hundred seventy-two adult, co-operative patients consecutively admitted to ICU for more than 24 h, and their relatives were interviewed. The instruments used were two questionnaires suitable for ICU patients: QOL-IT and QOL-SP. Interobserver reproducibility was investigated in 36 patients. RESULTS: Interobserver reproducibility was nearly perfect (weighted Kappa 0.99 for QOL-IT and QOL-SP). Considering global scores, weighted Kappa was 0.78 for QOL-IT and 0.82 for QOL-SP, with the mean difference between patients and relatives lower than 0.3 for both scores but with limits of agreement wider than 4. Among the items, concordance was excellent in the areas of physical activity and social life for both questionnaires. Gender, living together with the patient and the degree of relationship of relatives did not influence the agreement. CONCLUSIONS: The relatives give global scores for both instruments which can be regarded as acceptable substitutes for those given by patients. However, the wide limits of agreement should make investigators cautious in analysing together scores generated by patients and by relatives. The emotional dimension seems to be assessed less accurately by relatives than the physical one.

Aged↗

Predictors of weaning outcome in chronic obstructive pulmonary disease patients.

Several threshold values for predicting weaning outcome from mechanical ventilation have been proposed. These values, however, have been obtained in nonhomogeneous patient populations. The aim of the present study was to determine the threshold values in chronic obstructive pulmonary disease (COPD) patients and compare them to those reported for nonhomogeneous patient populations. The initial weaning trial included 81 COPD patients. Fifty-three of them underwent a successful weaning trial, whereas 28 failed it. The latter were enrolled into the present investigation, and were restudied during a subsequent successful trial. The weaning indices used were those reported in the literature. The threshold values obtained were within 10% of those reported for a nonhomogeneous patients population only for tidal volume and effective compliance. The classification error was <20% for maximal inspiratory pressure (MIP), occluded inspiratory pressure swing (deltaPI)/MIP, rapid and shallow breathing (respiratory frequency/tidal volume), and compliance, rate, oxygenation, pressure index (CROP), whereas the area under the receiver operating characteristic curves was >0.9 only for deltaPI/MIP and CROP. In conclusion, the threshold values obtained in chronic obstructive pulmonary disease patients who failed the first weaning attempt differed from those previously reported. Although a gold standard weaning index is not available for chronic obstructive pulmonary disease patients, the occluded inspiratory pressure swing/ maximal inspiratory pressure and compliance, rate, oxygenation, pressure index may be candidates for such a role.

Acute Disease↗

Plasma dopamine concentration and effects of low dopamine doses on urinary output after major vascular surgery.

To evaluate plasma dopamine concentration and the effects of low doses infusion on urinary output after abdominal vascular surgery in patients with renal function impairment we performed a prospective clinical study. Twenty hemodynamically stable patients (mean age 66.6 years), with serum creatinine concentration < 2 mg %, who undergoing general anesthesia for major vascular surgery participated. A low dose of dopamine (3 micrograms/kg/min) was administrated to patients with postoperative protracted urinary output < 0.5 ml/kg/hr for at least eight hours. Plasmatic determinations were taken at T0 (no dopamine administration), when urinary output began to increase, or if not, after two hours (T1), at eight (T2), and 24 (T3) hours after the beginning of infusion. After 24 hours the dopamine infusion was stopped and the patient's plasmatic level was measured four hours later (T4). Dopamine plasma concentrations were measured using high-performance liquid chromatography. Plasma dopamine concentration increased in all patients and reached a steady state at T2 (T2 = 76.41 +/- 16.84 ng/ml). Dopamine induced a concentration-dependent increase in urinary output (T0 = 0.45 +/- 0.14; T1 = 1.49 +/- 1.11; T2 = 2.34 +/- 1.44; T3 = 1.57 +/- 0.57; T4 = 0.85 +/- 0.7 ml/kg/hr). Three patients did not have an enhanced urinary output after dopamine infusion; they did have a prolonged clamping time and operation time (162 +/- 24 and 570 +/ 30 min, respectively). We conclude that low dose dopamine induces a dose-dependent increase of urinary output. This phenomenon also has been found in patients when their plasma concentration had not yet reached the steady-state. Lack of responsiveness to dopamine suggests a renal function impairment probably due to the prolonged aortic clamping time.

Acute Kidney Injury↗

[Analysis of quality of life. Development of an evaluation instrument].

OBJECTIVE: To develop a questionnaire about quality of life (QV) suitable for Intensive Care Unit (ICU) patients. DESIGN: Two prospective studies by direct interviews; in the first one the questionnaire was answered before and after surgical intervention and in the second during ICU stay and six months after hospital discharge. SETTING: Surgical ward and surgical-medical ICU. MATERIALS AND METHODS: Adult, co-operative patients, resident near the hospital, who gave informed consent have been interviewed. The following items of QOL were investigated: residence, physical activity, social life, perceived QV, oral communication and functional limitation, considering age. The last two items were assessed by the interviewer. RESULTS: Inter-observer reliability on oral communication and functional limitation, assessed by two interviewers in 87 surgical patients, was good (p = 0.68 and p = 0.72 respectively). Validation of the questionnaire in 37 surgical cases showed worsening in all the items, consistent with theoretical prediction. In the 152 ICU consecutively admitted eligible patients, physical activity, social life, functional limitation and global QV (sum of all the investigated items) significantly changed. Residence, perceived QV and oral communication did not change. Internal consistency of the instrument was good (p < 0.05). CONCLUSIONS: The evaluative instrument studied shows good reliability and validity. The authors suggest a shorter questionnaire could be tested in future investigations.

Activities of Daily Living↗

[Intensity of treatment and severity of illness in the intensive care unit (ICU)].

OBJECTIVE: To investigate the relationship between Therapeutic Intervention Scoring System (TISS), length of ICU stay and severity of illness. DESIGN: Prospective study lasting 1 year. SETTING: Two 4-bed surgical-medical ICU. PATIENTS: All consecutively ICU admitted patients. METHODS: Every day TISS of each patient during the last 24 h was computed. Age, sex, type of admission, SAPS II and APACHE II, length of ICU stay and hospital outcome were recorded. Out of 446 admissions, 14 were excluded since the ICU stay was < 16 h. Severity of illness was considered in 405 of the remaining 432; total TISS of readmitted patients resulted from all ICU admissions during the same hospital stay. RESULTS: Median TISS on day 1 was 24 (range 3-58, CI 95% 0.57) and median TISS +/- CI 95% during the first 10 ICU days ranged from 20 to 26. Spearman's correlation coefficient between TISS total and length of stay in ICU was 0.962. Total TISS increased with risk of hospital death predicted by both SAPS II and APACHE II. Total TISS of non surviving patients was significantly (p < 0.001) higher than that of the surviving up to probability of death of 20%. CONCLUSIONS: Intensity of treatment is essentially steady and total TISS is well related to length of ICU stay. Total TISS increases with increasing risk of hospital death predicted by SAPS II and APACHE II, but it is high especially in non surviving patients with low probability of hospital mortality at the admission.

APACHE↗

[Respiratory circuits and infections of the airway].

OBJECTIVE: To study the effects of ventilator circuit changes on the rate of airway infections and to investigate the relationship between the microorganisms responsible for circuit colonization and those responsible for infection. DESIGN: Prospective study, carried out in two different periods, of one year duration each. SETTING: General Intensive Care Units (ICUs) in a University Hospital. PATIENTS: Seventy-eight patients, requiring mechanical ventilation (VAM) for more than 5 days, were enrolled. They were divided into two groups: in the first (group I, n. 36, 1st period) the ventilator circuit was changed every 5 days; in the second (group II, n. 42, 2nd period) every 10 days. INTERVENTION: Ventilator circuit change every 5 or 10 days. Daily culvert and filling of cascade humidifiers with sterile irrigation water. Daily replacement of mount catheter. MEASUREMENTS: Qualitative cultures of tracheobronchial aspirate and of fluid from the humidifying cascades and the expiratory tubing traps. RESULTS: The two groups were similar. Pneumonia and tracheobronchitis were found in the 25% and 11% of patients of group I and in 26% and 12% of those of group II respectively. The VAM duration was 26.5 +/- 15 days in patients who developed airway infection, and 12.9 +/- 11.6 days (p < 0.001) in patients who did not. The Gram+ organisms were predominant. An identical microorganism was found both in the tracheo-bronchial aspirate and in the circuit in 44 of 78 (56%) patients; no difference was found between infected (16 of 29) and non infected (28 of 49) patients. CONCLUSIONS: Changing the ventilator circuit every 10 days rather than every 5 days, does not increase the incidence of airway infections and result in considerable savings in the expenses of tubing and personnel time. The infection or colonization rates due to the same microorganisms are quite low and it seems not useful to make routine cultures of fluid from humidifying cascades and the expiratory tubing traps in order to characterize in time the microorganism that could be responsible of airway infections.

Adult↗

Survival and quality of life after intensive care.

OBJECTIVE: To determine survival and changes in quality of life (QOL) after hospital discharge in patients who had stayed in an intensive care unit (ICU). DESIGN: Prospective study by direct interviews during ICU stay and 6 months after hospital discharge. SETTING: Surgical-medical ICU. PATIENTS AND METHODS: We interviewed cooperative, adult patients admitted consecutively to the ICU for more than 24 h, living near the hospital, who gave informed consent. The following QOL domains were investigated: residence, physical activity, social life, perceived QOL, oral communication and functional limitation. RESULTS: One-year survival was 82.4% (predicted 84%). Mortality was 36.3% after urgent neoplastic surgery, 19.4% for medical admissions and 4.9% after non-neoplastic surgery. Of 160 patients studied, eight cases, older and already deteriorated at the first interview, could not respond to the perceived QOL item after ICU discharge. In the other 152 patients, physical activity was reduced in 31% (usually slightly), social life had worsened in 32% and functional limitation increased in 30%. The perceived QOL did not change. CONCLUSIONS: After hospital discharge, the survival of ICU-admitted patients is comparable to that of the general population and not related to ICU treatments. Most patients maintain their physical activity and social status at the preadmission level. Any worsening, if present, is slight and does not influence perceived QOL.

Activities of Daily Living↗

[Survival in intensive care of patients with chronic obstructive bronchopneumopathy and acute respiratory failure undergoing mechanical ventilation. Retrospective study].

OBJECTIVE: To collect valuable informations for the evaluation of the patients' clinical evolution and to perform a cost-effectiveness analysis on the utilization of resources in the management of patients with chronic obstructive pulmonary disease (COPD) undergoing mechanical ventilation (MV) for acute respiratory failure (ARF). SETTING: General ICU. University Hospital. PATIENTS: 87 BPCO patients (mean age: 69.6 +/- 8.5) undergoing MV for ARF due to non surgical or traumatic events, for a total of 108 consecutive ICU admissions between January 1983 and December 1993. METHODS: Retrospective study in which the following data were collected: severity of the underlying chronic respiratory disease before the occurrence of ARF. For this aim patients have been divided into five classes (O-IV) according with ATS classification of dyspnea; causes of ARF; SAPS score; TISS score; OMEGA score; complications occurred in ICU; duration of MV; duration of stay in ICU; ICU and hospital outcome. RESULTS: In 48 cases (44.4%) clinical history was positive for a severe dyspnea (classes III-IV). Slight airway flogosis or infection were responsible of ARF in 78 cases; pneumonia was present in 24 cases while in 6 cases ARF was due to congestive heart failure. The study population was divided into two groups according with outcome. No statistically significant difference was observed in mean SAPS and TISS scores between the two groups (12.5 +/- 3 vs 13 +/- 4.8 and 18.4 +/- 2.3 vs 19 +/- 4.2). Mean OMEGA score was 155 +/- 11.7 (ES). With reference to ICU outcome the utilization rate or resources was 72.15% with a mean loss of resources of 43.2. Compli-cations were manly due to airway infection (16 cases) which was responsible in one case of the patient's death. Overall incidence of complications was relatively low and five of them led to patients' death in ICU. Mean duration of MV did not differ between the two groups (13.4 +/- 11.7 vs 14.3 +/- 11.7) but it was significantly longer in those patients whose clinical history was positive for severe dyspnea (classes III and IV) than in patients without this report (16.6 +/- 14.9 vs 10.9 +/- 6.9; p < 0.05). Mean stay in ICU did not differ significantly between survivors and non-survivors (21.4 +/- 18.6 vs 19.7 +/- 13). ICU mortality rate was 6.48% (7 patients) and hospital mortality rate was 20.3% (22 patients). CONCLUSIONS: Our results demonstrate that hospital outcome in COPD patients with ARF requiring mechanical ventilation is quite good. Prolonged mechanical ventilation and--severity of underlying chronic respiratory disease do not affect significatively the prognosis. The high costs of the treatment of these patients are counterbalanced by a good efficiency of utilization of resources and appreciable clinical results.

Aged↗

[Complete neurological recovery following prolonged cardiac arrest. Description of a clinical case].

We report a case of protracted intraoperative cardiac arrest (15 minutes), occurring in a patient with haemorrhagic shock in consequence of a bullet wound to the right hemithorax; external cardiac massage was immediately started and carried on until the restoration of spontaneous cardiac activity. In the immediate postoperative period, the patient presented seizure activity, treated with TPS in continuous infusion (2 mg/kg/h) and DPH (250 mg/die). Anticonvulsant therapy didn't allow a correct neurologic evaluation of the patient; that was possible only when treatment was suspended (4 days after ICU admission). Neurophysiological investigations (EEG and Somato-Sensorial Evoked Potentials) were undertaken; particularly SSEPs recorded no pathologic alteration of the cortical response. At the discharge from ICU the patient was completely awake after coma, a residual paresis of the right lower limb was present. We suggest that in post-anoxic coma, when anticonvulsant therapy is required, neurophysiological investigations improve the accuracy of early outcome prediction.

Adult↗